DESCRIPTION: (Applicant's Abstract) Despite the widespread availability of effective treatment for diabetic retinopathy and large-scale, concerted efforts to educate and motivate the public, patients, and health care providers about eye care for diabetics, nearly 6000 patients still become blind each year from retinopathy. By applying the precepts of patient-centered care and total quality management to an analysis of why the health care system is not successful in preventing such blindness, new insights as to why blindness occurs and why health care is not being used as recommended by practice standards will allow us to better direct future intervention efforts. Use of 35 total focus groups with patients with and without blindness from diabetic retinopathy, their family and social support members, and health care providers engaged in treating diabetics will shed new light on unrecognized factors and especially interactions among factors with patients, their support system, health care providers, and the structure and processes of the health care delivery and financing systems. Such insights can then be validated by a subsequent case-control analysis of 200 (100 blind in at least one eye, 100 not) patients, involving analysis of not only their medical records but actual interviews of the patients, their families or support givers, and their treating physicians and providers. The objective of the study is to provide understanding of why the current system is unsuccessful and where future efforts may have the greatest potential for success, especially in light of ongoing and proposed changes in our health care system.